Home-based health promotion for chronically ill older persons: results of a randomized controlled trial of a critical reflection approach

The purpose of this study was to test a health promotion intervention for people over 65 years of age discharged from hospital to care at home for chronic medical conditions. Researchers hypothesized that chronically ill older people who received the intervention would have a significantly more positive mindset (or attitude toward their life, self, health, and health care), would use significantly less hospital and home care services, and would have a significantly better quality of life. At the time of discharge from hospital, 298 seniors were randomized to receive the usual home care plus the intervention, or to an attention control group receiving the usual home care. The intervention was comprised of approximately 10 weekly hour-long sessions in which a nurse facilitated critical reflection on life and health. Data collected by personal interview at baseline, 22 weeks, and 1 year later were analyzed using ANOVA and logistic regression, controlling for age, gender, living arrangements, accommodation, number of chronic medical problems and baseline differences, as appropriate. Results: Those who received the intervention had significantly greater independence (p = 0.008) and perceived ability to manage their own health (p = 0.014) and significantly less desire for information (p = 0.021) immediately post-intervention. At the 1-year follow-up, the pattern persisted, although significant differences were limited to independence (p = 0.007) and desire for information (p = 0.035). As well, at 1-year the intervention group had higher yet more significantly declined self-care agency (p = 0.025) and locus of authority (p = 0.017). Comparison of changes in health resource utilization by the two groups did not differ significantly. However, the intervention group had a significantly greater (p = 0.006) chance of having higher quality of life immediately post-intervention. This trend persisted at 1 year, although differences were non-significant. Results suggest the clinical potential of critical reflection to enhance the health of chronically ill older persons. Further investigation with less frail populations is needed.